ISSN 1671-5411 CN 11-5329/R
Volume 17 Issue 8
Sep.  2020
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Article Contents
Jordy Mehawej, Jane Saczynski, Jerry H. Gurwitz, Hawa O. Abu, Benita A. Bamgbade, Wei-Jia WANG, Tenes Paul, Katherine Trymbulak, Connor Saleeba, Zi-Yue WANG, Catarina I. Kiefe, Robert J. Goldberg, David D. McManus. Self-reported risk of stroke and factors associated with underestimation of stroke risk among older adults with atrial fibrillation: the SAGE-AF study. J Geriatr Cardiol 2020; 17(8): 502-509. doi: 10.11909/j.issn.1671-5411.2020.08.004
Citation: Jordy Mehawej, Jane Saczynski, Jerry H. Gurwitz, Hawa O. Abu, Benita A. Bamgbade, Wei-Jia WANG, Tenes Paul, Katherine Trymbulak, Connor Saleeba, Zi-Yue WANG, Catarina I. Kiefe, Robert J. Goldberg, David D. McManus. Self-reported risk of stroke and factors associated with underestimation of stroke risk among older adults with atrial fibrillation: the SAGE-AF study. J Geriatr Cardiol 2020; 17(8): 502-509. doi: 10.11909/j.issn.1671-5411.2020.08.004

Self-reported risk of stroke and factors associated with underestimation of stroke risk among older adults with atrial fibrillation: the SAGE-AF study

doi: 10.11909/j.issn.1671-5411.2020.08.004
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  • Corresponding author: Jordy Mehawej, MD, Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA. E-mail: Jordy.Mehawej@umassmed.edu
  • Received Date: 2020-05-02
  • Accepted Date: 2020-07-18
  • Rev Recd Date: 2020-06-02
  • Available Online: 2020-08-28
  • Publish Date: 2020-09-07
  •  Background Though engaging patients with atrial fibrillation (AF) in understanding their stroke risk is encouraged by guidelines, little is known regarding AF patients' perceived stroke risk or its relationship with oral anticoagulation (OAC) use. We aim to identify factors associated with underestimation of stroke risk among older patients with AF and relate this to OAC use. Methods Data are from the ongoing SAGE (Systematic Assessment of Geriatric Elements)-AF study, which included older patients (> 65 years) with non-valvular AF and a CHA2DS2-VASc score of ≥ 2. Participants reported their perceived risk of having a stroke without OAC. We compared the perceived risk to CHA2DS2-VASc predicted stroke risk and classified participants as "over" or "under" estimators, and identified factors associated with underestimation of risk using multiple logistic regression. Results The average CHA2DS2-VASc score of 915 participants (average age: 75 years, 47% female, 86% white) was 4.3 ± 1.6, 43% of participants had discordant predicted and self-reported stroke risks. Among the 376 participants at highest risk (CHA2DS2-VASc score ≥ 5), 46% of participants underestimated their risk. Older participants (≥ 85 years) were more likely and OAC treated patients less likely to underestimate their risk of developing a future stroke than respective comparison groups. Conclusions A significant proportion of study participants misperceived their stroke risk, mostly by overestimating. Almost half of participants at high risk of stroke underestimated their risk, with older patients more likely to do so. Patients on OAC were less likely to underestimate their risk, suggesting that successful efforts to educate patients about their stroke risk may influence treatment choices.
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  • [1]
    Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 2014; 129: 837-847. doi: 10.1161/CIRCULATIONAHA.113.005119
    [2]
    Morillo CA, Banerjee A, Perel P, et al. Atrial fibrillation: the current epidemic. J Geriatr Cardiol 2017; 14: 195-203.
    [3]
    Savelieva I, Camm J. Update on atrial fibrillation: part Ⅰ. Clin Cardiol 2008; 31: 55-62.
    [4]
    Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke 1991; 22: 983-988. doi: 10.1161/01.STR.22.8.983
    [5]
    Wolf PA, Dawber TR, Thomas HE Jr, et al. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology 1978; 28: 973-977.
    [6]
    Christiansen CB, Gerds TA, Olesen JB, et al. Atrial fibrillation and risk of stroke: a nationwide cohort study. Europace 2016; 18: 1689-1697. doi: 10.1093/europace/euv401
    [7]
    Risk factors for stroke and efficacy of antithrombotic therapy in atria1 fibrillation Analysis of pooled data from five randomized controlled trials. Arch lntern Med 1994; 154: 1449-1457.
    [8]
    Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 2010; 137: 263-272.
    [9]
    Friberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J 2012; 33: 1500-1510. doi: 10.1093/eurheartj/ehr488
    [10]
    Mason PK, Lake DE, DiMarco JP, et al. Impact of the CHA2DS2-VASc score on anticoagulation recommendations for atrial fibrillation. Am J Med 2012; 125: 603.e1-603.e6036. doi: 10.1016/j.amjmed.2011.09.030
    [11]
    Olesen JB, Torp-Pedersen C, Hansen ML, et al. The value of the CHA2DS2-VASc score for refining stroke risk stratifica tion in patients with atrial fibrillation with a CHADS2 score 0-1: a nationwide cohort study. Thromb Haemost 2012; 107: 1172-1179.
    [12]
    January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140: e125-e151.
    [13]
    Ogilvie IM, Newton N, Welner SA, et al. Underuse of oral anticoagulants in atrial fibrillation: a systematic review. Am J Med 2010; 123: 638-645.e4. doi: 10.1016/j.amjmed.2009.11.025
    [14]
    Kew GS, Tan M, Lim TW. Poor adherence to anticoagulation guidelines in patients with non-valvular atrial fibrillation treated in a tertiary cardiology unit. Heart Asia 2015; 7: 18-22. doi: 10.1136/heartasia-2014-010600
    [15]
    Ingelgå rd A, Hollowell J, Reddy P, et al. What are the barriers to warfarin use in atrial fibrillation? Development of a questionnaire. J Thromb Thrombolysis 2006; 21: 257-265. doi: 10.1007/s11239-006-5633-2
    [16]
    Gattellari M, Worthington J, Zwar N, et al. Barriers to the use of anticoagulation for nonvalvular atrial fibrillation: a repre sen tative survey of Australian family physicians. Stroke 2008; 39: 227-230. doi: 10.1161/STROKEAHA.107.495036
    [17]
    Aliot E, Breithardt G, Brugada J, et al. An international survey of physician and patient understanding, perception, and atti tudes to atrial fibrillation and its contribution to cardiovascular disease morbidity and mortality. Europace 2010; 12: 626-633. doi: 10.1093/europace/euq109
    [18]
    Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in colla boration with EACTS. Eur Heart J 2016; 37: 2893-2962. doi: 10.1093/eurheartj/ehw210
    [19]
    Saczynski JS, Sanghai SR, Kiefe CI, et al. Geriatric elements and oral anticoagulant prescribing in older atrial fibrillation patients: SAGE-AF. J Am Geriatr Soc 2020; 68: 147-154. doi: 10.1111/jgs.16178
    [20]
    Wang W, Saczynski J, Lessard D, et al. Physical, cognitive, and psychosocial conditions in relation to anticoagulation satisfaction among elderly adults with atrial fibrillation: the SAGE-AF study. J Cardiovasc Electrophysiol 2019; 30: 2508-2515. doi: 10.1111/jce.14176
    [21]
    Odum LE, Cochran KA, Aistrope DS, et al. The CHADS2 versus the new CHA2DS2-VASc scoring systems for guiding antithrombotic treatment of patients with atrial fibrillation: review of the literature and recommendations for use. Pharmacotherapy 2012; 32: 285-296. doi: 10.1002/j.1875-9114.2012.01023.x
    [22]
    Spertus J, Dorian P, Bubien R, et al. Development and validation of the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire in patients with atrial fibrillation. Circ Arrhythm Electrophysiol 2011; 4: 15-25. doi: 10.1161/CIRCEP.110.958033
    [23]
    Cano SJ, Lamping DL, Bamber L, et al. The Anti-Clot Treatment Scale (ACTS) in clinical trials: cross-cultural vali dation in venous thromboembolism patients. Health Qual Life Outcomes 2012; 10: 120. doi: 10.1186/1477-7525-10-120
    [24]
    Maly RC, Frank JC, Marshall GN, et al. Perceived efficacy in patient-physician interactions (PEPPI): validation of an instru ment in older persons. J Am Geriatr Soc 1998; 46: 889-894. doi: 10.1111/j.1532-5415.1998.tb02725.x
    [25]
    Zweiker D, Zweiker R, Winkler E, et al. Association between subjective risk perception and objective risk estimation in patients with atrial fibrillation: a cross-sectional study. BMJ Open 2017; 7: e018242.
    [26]
    Hijazi M, Aljohani S, Algahtani F, et al. Perception of the risk of stroke and the risks and benefits of oral anticoagulation for stroke prevention in patients with atrial fibrillation: a cross- sectional study. Mayo Clin Proc 2019; 94: 1015-1023. doi: 10.1016/j.mayocp.2018.08.043
    [27]
    Holm AL, Berland AK, Severinsson E, et al. Older patients' involvement in shared decision-making: a systematic review. Open J Nurs 2016; 6: 170-185. doi: 10.4236/ojn.2016.63018
    [28]
    Seaburg L, Hess EP, Coylewright M, et al. Shared decision making in atrial fibrillation: where we are and where we should be going. Circulation 2014; 129: 704-710. doi: 10.1161/CIRCULATIONAHA.113.004498
    [29]
    Oldgren J, Healey JS, Ezekowitz M, et al. Variations in cause and management of atrial fibrillation in a prospective registry of 15, 400 emergency department patients in 46 countries: the RE-LY Atrial Fibrillation Registry. Circulation 2014; 129: 1568-1576. doi: 10.1161/CIRCULATIONAHA.113.005451
    [30]
    Kapoor A, Amroze A, Vakil F, et al. Support-AF II: supporting use of anticoagulants through provider profiling of oral anti coagulant therapy for atrial fibrillation: a cluster-randomized study of electronic profiling and messaging combined with aca demic detailing for providers making decisions about anticoa gulation in patients with atrial fibrillation. Circ Card iovasc Qual Outcomes 2020; 13: e005871.
    [31]
    Eckman MH, Costea A, Attari M, et al. Shared decision- making tool for thromboprophylaxis in atrial fibrillation: a feasibility study. Am Heart J 2018; 199: 13-21.
    [32]
    Siontis KC, Montori VM, Noseworthy PA. Multimodal inter ventions to increase anticoagulant utilization in atrial fibrilla tion: futile without patient engagement?. Circ Cardiovasc Qual Outcomes 2020; 13: e006418.
    [33]
    Smet L, Heggermont WA, Goossens E, et al. Adherence, know ledge, and perception about oral anticoagulants in patients with atrial fibrillation at high risk for thromboembolic events after radiofrequency ablation. J Adv Nurs 2018; 74: 2577-2587. doi: 10.1111/jan.13780
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